Structural reform of the NHS is not a performance

It is early to know exactly what the NHS reforms in England are going to mean – the initial signs are that this policy has been overly influenced by the government's PR advisers who seem in thrall to Elon Musk and seem to be placing undue weight on the power of Artificial Intelligence.

It is therefore unclear that this is the kind of structural reform the NHS needs and rather too much suggestion that this is a struggling government flailing around and trying to emulate the Trump regime for brownie points.

That does not mean there isn't an need for a structural reform of the NHS in Scotland. We have created a system which is genuinely top-heavy, littered with inefficient manager-pleasing bureaucracy and paperwork, has disempowered its frontline staff and – this the UK government is right about – is insufficiently democratically accountable, nestled as it is behind walls of unelected agencies, quangos and health boards.

Common Weal's solution to this is quite different from what seems to be being proposed down south. Rather than the assumption that the future of the NHS lies in unproven new technology, we believe that it should start by remembering what we used to do better in healthcare and to relearn truths about human health we seem to have forgotten.
For example, it remains the case that good health outcomes require time. That means time for good diagnoses. It means time for medical professionals to spend with patients (patients have markedly better responses to medical treatment when they trust their medics). It means proper staffing support during the intensive period of recovery and it means allowing a longer time for humans to recuperate than the 'get them back to work as quickly as possible' culture we have.

We believe the NHS should be led by medical professionals, not management and finance professionals. Good administration is essential, but administration should not drive the NHS, healthcare should. Health Boards should be elected by staff and patient groups and so be responsive to staff and patient needs. Management should be slimmed down and a 'frontline first' approach should be taken where any expenditure in the system that is not boosting capacity at the frontline should be rigorously questioned.

We need a very substantial slimming down of bureaucracy and a system of 'self management' where medical professionals operate in teams and manage themselves and their basic budgets, supported by a light admin team. To support this we need a competent system of patient data orientated around a universal personal data store.

And we need a less monolithic, much more decentralised system where people are able to recuperate and get basic healthcare support closer to home in facilities which are not designed for the most intensive care but for the much more basic care and monitoring that often overwhelms the system.

You can find out more about Common Weal's vision for health in the health chapter of Sorted (which will be on the website soon and can be purchased as a book here).